PROJECT SUMMARY Binge eating disorder (BED) is a debilitating condition that is strongly associated with obesity and is the most common eating disorder in the US. Little is known about mechanisms underlying BED, hampering development of more efficacious treatment approaches. In particular, few studies have examined neural mechanisms related to BED, and how treatment effects neural activity. Building upon Dr. Ariana Chao's previous research and training experiences, this K23 application prepares the candidate to become an independent,patient-oriented nurse researcher. Her long-term goal is to contribute to efforts to reduce the obesity epidemic by investigating biobehavioral pathways associated with BED and obesity, and developing precisely targeted and innovative interventions for prevention and treatment. In the short-term, the current proposal will allow Dr. Chao to obtain new knowledge and skills through a seminars, (Mentor: Richmond tailored set of formal courses, workshops and experiential learning guided by an accomplished, interdisciplinary mentorship team Dr. Thomas Wadden; Co-Mentors: Dr. Ruben Gur nd Dr. Carlos Grilo; Consultants: Dr. Therese and Dr. Russell Shinohara). In addition, Dr. Chao will , a conduct a randomized controlled trial (RCT) assessing the impact of CBT on neural responses to binge eating stimuli. Females who are obese with BED will be randomized to either a 16-week, one-on-one CBT intervention (n=20) or a waitlist control (WL; n=20). Both groups will have blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) scans at baseline and after the 16-week intervention. During the scans, participants will complete two tasks: one to assess inhibition to food (i.e., food-specific stop signal task (SST)) and one to evaluate reward response to recall of binge foods (i.e., script-driven imagery). The primary aims of the study are to: 1) compare differences between the CBT and WL groups at week 16 in changes in BOLD fMRI response to food-specific SST; 2) compare differences between the CBT and WL groups at week 16 in changes in BOLD fMRI response to script-driven imagery of binge foods; and 3) determine whether pre-treatment neural activation on the SST and script-driven imagery task predict differences between CBT responders and non-responders (>1 binge eating episode in the past 28 days). Our exploratory aim is to: 4) assess the associations between pre- to post- treatment behavioral changes in reported binge eating episodes (percent reduction and categorical response), in reward-based eating drive, and in dietary inhibition, and pre- to post-treatment neural changes on the SST and script-driven imagery task. This study will provide an important foreground to improve the precision of prevention and treatment strategies for BED and obesity. The research and training plans are responsive to the National Institute of Nursing Research's goals of integrating biological and behavioral sciences to promote personalized health strategies and applying new technologies to promote self-management interventions that improve health and patient outcomes.